Regional cerebral blood flow in juvenile systemic lupus erythematosus: a prospective SPECT study. Single photon emission computed tomography.

OBJECTIVE: Using single photon emission computed tomography (SPECT) we evaluated the presence and evolution of changes in brain perfusion in juvenile systemic lupus erythematosus (JSLE). METHODS: SPECT was performed in 14 patients with active JSLE divided in 2 groups: the first included 7 patients without central nervous system (CNS) involvement and the second 7 patients with minor neuropsychiatric symptoms (headache, reactive depression, cognitive impairment, mood swing). SPECT findings were compared to seroimmunological and magnetic resonance imaging (MRI) data. After 6 month followup, a second SPECT scan was performed in 12 of 14 patients. RESULTS: At baseline, SPECT showed perfusion defects in 2 patients without neuropsychiatric symptoms and in 5 patients with CNS involvement. In one of the 7 patients with altered SPECT, MRI showed focal hyperintensities. MRI alterations were observed in another patient who had a normal SPECT scan. Cortical atrophy was present in 5 of 14 patients. Correlation between neuropsychiatric manifestations and SPECT findings was not clearly evident because the major part of JSLE patients with CNS involvement and with SPECT alterations had multiple symptoms, but showed focal hypoperfusion on SPECT imaging. No significant association was found between seroimmunological data and SPECT findings. At followup, improvement of perfusion alterations was observed in 6 of 7 patients with altered SPECT and, in 3 of them, findings might be attributed to changes in steroid treatment. CONCLUSION: Perfusion abnormalities in SLE may represent reversible lesions or subclinical CNS involvement. Moreover, SPECT imaging appears to be useful in detecting and monitoring CNS involvement in SLE.

Metastatic tumor of the spermatic cord from a primary silent colorectal adenocarcinoma.

Tumors of the spermatic cord are indeed rare and 91% are of mesenchymal origin. Nearly all epithelial tumors are metastases with the primary tumor located in the gastrointestinal tract, prostate, kidney. In 9.5% of cases, initial symptoms are localized to the metastatic site prior to the discovery of the primary tumor. When a diagnosis of epithelial malignant tumor of the spermatic cord is made an investigation for the primary site must be performed. We report a case of metastatic tumor of the right spermatic cord occurring as first clinical manifestation of a silent adenocarcinoma of the sigmoid colon.

Magnetic resonance imaging of renal osteodystrophy in children.

BACKGROUND: Improved life expectancy of children with chronic renal failure (CRF) has increased the number of patients with renal osteodystrophy and has brought to light novel and severe forms of the disease. These factors have contributed to the need to evaluate new, noninvasive imaging modalities for the detection of bone involvement. OBJECTIVES: To evaluate the potential of MRI in the detection of the bone changes of renal osteodystrophy as compared to conventional X-rays. MATERIALS AND METHODS: Fourteen children with CRF were examined with a 0.5-T MR unit using TI-weighted and STIR sequences and conventional radiographs. The following features were reviewed in a nonblinded study: skeletal deformities, thickening of cortical bone, trabecular pattern, intraosseous soft-tissue masses, osteonecrosis, extraskeletal calcifications and bone marrow signal changes. RESULTS: MRI adequately demonstrated skeletal deformities, cortical thickening and irregular trabecular pattern. It showed osteonecrosis and intraosseous soft-tissue masses more conspicuously than X-ray. In addition, it revealed diffuse nonspecific signal changes in the bone marrow. CONCLUSION: MRI is a potentially useful tool for evaluating the bone changes of renal osteodystrophy.

[Magnetic resonance with an endorectal coil and a fast spin echo sequence in the staging of prostatic carcinoma. The correlation with histopathological data]. / Risonanza Magnetica con bobina endorettale e sequenza Fast Spin Echo nella stadiazione del carcinoma prostatico. Correlazione con i dati istopatologici.

INTRODUCTION: We investigated the accuracy of endorectal coil Magnetic Resonance Imaging (MRI) and Fast Spin Echo (FSE) technique in staging prostate cancer. MATERIAL AND METHODS: MRI was performed in 70 patients with biopsy proved prostatic cancer. A total of 33 patients subsequently underwent radical prostatectomy. T2-weighted FSE sequences (TR 3400-4100, TE 120, Echo train length 13) were acquired in all patients. Axial, sagittal and coronal 4-5 mm images were obtained with 13-14 cm field of view and 256 x 256 matrix. Additional T1-weighted spin echo images were acquired in 9 patients. Lesion staging on MR images was performed according to the American Urological System. MR data were compared with the pathologic findings of whole-mount sections of the surgical specimens. RESULTS: Overall accuracy for endorectal coil MR imaging was 60%; ten cases were underestimated and 3 cases were overestimated. The sensitivity and the specificity of endorectal coil MRI in diagnosing capsular penetration were 77% and 81%, respectively. Seminal vesicle invasion was detected with 87% sensitivity and 96% specificity. CONCLUSIONS: Endorectal coil MRI provides a more accurate preoperative local staging.

Dumbbell stone of prostatic fossa after prostatectomy. A combined ESWL and suprapubic percutaneous treatment.

We report our experience with a combined treatment of extracorporeal shock wave lithotripsy and percutaneous suprapubic lithotripsy for a dumbbell-shaped stone of prostatic fossa associated with multiple bladder calculi, in the same operative session. Because of the successful result, we believe the association of the two treatments for this complex calculus to be an easy, effective and minimally invasive method. ESWL should be considered for the primary management of these rare calculi, suprapubic percutaneous endoscopy can be helpful in rapid and complete removal of fragments.

[Magnetic resonance with endorectal coil in the locoregional staging of rectal carcinoma]. / La risonanza magnetica con bobina endorettale nella stadiazione loco-regionale del carcinoma del retto.

The accurate locoregional staging of rectal cancer is important in choosing and planning therapy. The diagnostic contribution of endorectal ultrasonography and of Computed Tomography is well known because both methods have been widely used in the last ten years. More recently, Magnetic Resonance Imaging (MRI) has been introduced in the preoperative staging of rectal cancer: most interestingly, in the last three years endorectal surface coils have become available as a clinical device. February through November, 1994, twenty patients affected with rectal carcinoma were examined with endorectal MRI. In order to assess their accuracy, MR staging results were compared with pathologic findings. MRI was performed with an 0.5 T system equipped with an endorectal surface coil. In all cases T2-weighted turbo spin-echo sequences were performed on axial and sagittal or coronal planes. Rectal wall layers were reliably demonstrated in all patients. The comparison with pathologic findings showed 78.9% MR accuracy in assessing tumor infiltration depth. In addition, the study of perirectal lymph nodes showed 83.2% MR sensitivity and 53.8% MR specificity. The high resolution images obtained using endorectal surface coils and the well-known panoramic capabilities of this method reveal MR potentials in rectal carcinoma staging.

MR imaging with STIR technique and air insufflation for local staging of bladder neoplasms.

Fifty-six patients with bladder carcinoma were studied with MR imaging for the assessment of the local stage, using the inversion recovery pulse sequence with fat suppression (STIR) with air in the bladder. With this technique images of the inner and the outer parts of the bladder wall were obtained, showing high contrast between the latter and the tumor (tumor/muscle contrast 89.9%). Four tumor stages were recognized: superficial neoplasms (Tis, Ta, and T1), partial wall infiltrating neoplasms (T2); total wall infiltrating neoplasms (T3a, T3b), and neoplasms involving other pelvic organs (T4). MR imaging was compared with histopathologic diagnosis obtained at transurethral resection or cystectomy. True-positive diagnosis was obtained in 80.4%; false-positive in 14.3% of cases; false-negative in 5.3%. Despite the relatively high incidence of overstaged neoplasms, STIR technique combined with air in the bladder allowed a good accuracy in local staging.

[Role of endovesical echography in the assessment of bladder neoplasms]. / Ruolo dell'ecografia endovescicale nell'inquadramento delle neoplasie vescicali.

The correct assessment of T (depth of infiltration of bladder wall by cancer) is relevant to plan therapy. In fact, besides staging the local lesion, this can predict pelvic and lumboaortic lymphnode involvement (N parameter) statistically. At the INRCA Hospital in Florence, from January 1987 to December 1989, transurethral US was performed on 66 patients affected with bladder carcinomas, in order to assess the value of this diagnostic method; in all patients pathologic staging on surgical specimens from TUR (63 cases) and cystectomy (3 cases) was performed. Follow-up lasted 24 months at least. When comparing US staging (according to Holm classification) to postoperative histopathologic findings, our results showed that US tends to overstage the lesions, while no understaged tumors were seen in our series. Diagnostic accuracy was 70%. It must be pointed out that TRUS demonstrated hidden submucosal tumors in two patients previously treated with intravesical chemotherapy. Retrospectively, we were able to detect causes of error in cancer staging in some cases--i.e., large carcinomas, calcifications on tumors, radiotherapy scars, bladder wall inflammation due to intravesical BCG therapy. Moreover, some lesions which appeared to have been overstaged with TRUS and which had been treated according to histopathologic findings from TUR exhibited recurrence or disease progression. This was probably due to incomplete TUR and to the presence of residual tumor in the bladder wall.

[Magnetic resonance-diskography correlation for the therapeutic approach of lumbar herniated disk]. / Correlazione RM-discografia nell'approccio terapeutico all'ernia discale lombare.

In order to evaluate MR reliability in the therapeutic approach to lumbar disk herniation, 51 patients were examined. MR images revealed disk herniation with integrity of posterior longitudinal ligament in 25 subjects. These patients were then examined with diskography, that confirmed MR diagnosis in 23/25 cases. Percutaneous diskectomy according to Onik was successfully performed in 23/25 patients. MR imaging appears as a non-invasive method which allows exhaustive analysis of all components of lumbar spine, yielding reliable information for choosing the appropriate treatment.

[Gadolinium DTPA in a MR study of expansive lesions of the cranial base]. / Il Gadolinio DTPA nello studio RM delle lesioni espansive della base cranica.

Twenty-five patients were investigated by MR imaging in order to evaluate the diagnostic value of Gadolinium (Gd)-DTPA in skull-base tumors. The patients were studied with standard acquisition techniques (T1, mixed and T2-weighted images) without contrast medium. The images obtained were then compared with the T1-weighted images obtained after intravenous injection of Gd-DTPA. The contrastographic results in the different types of acquisition were evaluated. Thanks to the extraordinary increase in contrast resolution it provides, Gd-DTPA allowed the precise evaluation of the lesion and of its perfect spatial definition in all cases. Our experience demonstrated that Gd-DTPA considerably increases the sensitivity of the technique in this anatomical region. On the contrary, as regards the nature of the lesion, the signal did not significantly vary after the iv injection of Gd-DTPA in the various kinds of lesion. In addition to the important diagnostic advantages of Gd-DTPA, its excellent tolerability and the absence of side-effects must be stressed.